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Le Hanneur M, Bouché PA, Vignes JL, Poitevin N, Legagneux J, Fitoussi F. Nonliving versus Living Animal Models for Microvascular Surgery Training: A Randomized Comparative Study. Plast Reconstr Surg 2024; 153:853-860. [PMID: 37256834 DOI: 10.1097/prs.0000000000010755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Ethical and financial considerations have encouraged the use of nonliving models for simulation-based training in microsurgery, such as commercially available chicken thighs. The purpose of this study was to compare the nonliving chicken thigh model to the one currently considered as the standard-namely, the living rat model-in the setting of an initiation microsurgery course. METHODS Applicants to the 3-day basic microsurgery course of the Paris School of Surgery were assigned randomly to either one group that received the regular training of the school (RT group), including four hands-on sessions using only living rat models, or one group that received a modified curriculum in which a nonliving chicken thigh model was used for the first hands-on session (CT group). During the following session, all trainees were evaluated on living rat models, using a global rating scale and two task-specific scales (knot-tying and anastomosis); rates of anastomosis patency, animal survival, and technique completion were recorded. RESULTS Ninety-three residents were enrolled. Global rating scale, knot-tying, and anastomosis task-specific scale scores were significantly higher in the CT group ( n = 51) than in the RT group, with mean differences of 2.6 points ( P = 0.0001), 1.3 points ( P < 0.0001), and 1.4 points ( P < 0.0001), respectively. Patency and survival rates were significantly higher in the CT group than in the RT group, with mean differences of 22% ( P = 0.0020) and 27% ( P < 0.0001), respectively; completion rates were not statistically different. CONCLUSION Subject to the use of validated models, such as the chicken thigh, nonliving animal models are a suitable alternative to the living rat model in microsurgery initial training. CLINICAL RELEVANCE STATEMENT The use of validated non-living models, such as the chicken thigh, is a suitable alternative to the living rat model in microsurgery initial training.
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Affiliation(s)
- Malo Le Hanneur
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
- Hand to Shoulder Mediterranean Center, ELSAN
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Sorbonne University
| | - Pierre-Alban Bouché
- Department of Orthopedics and Traumatology, Lariboisière Hospital, Paris University
| | - Jean-Luc Vignes
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Nathalie Poitevin
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Josette Legagneux
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
| | - Franck Fitoussi
- From the Microsurgery Training and Research Laboratory, Paris School of Surgery
- Department of Pediatric Orthopedics, Armand Trousseau Hospital, Sorbonne University
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Marty-Diloy T, Rougereau G, Mary P, Vialle R, Fitoussi F, Pietton R, Langlais T. Induced-membrane technique for lower limb reconstruction after malignant bone tumour resection in paediatric patients: Complication and re-operation rates. Orthop Traumatol Surg Res 2024:103875. [PMID: 38556207 DOI: 10.1016/j.otsr.2024.103875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 04/02/2024]
Abstract
BACKGROUND The objective of this study was to assess the complication and re-operation rates, evaluate the risk of non-union, and describe the functional outcomes at last follow-up in children and adolescents after lower-limb malignant tumour resection and reconstruction using the induced-membrane technique. HYPOTHESIS Weight-bearing resumption 6 weeks after the second stage of the induced-membrane procedure promotes bone healing. MATERIAL AND METHODS The study included 13 patients (9 with osteosarcoma, 3 with Ewing's sarcomas, and 1 with alveolar sarcoma) managed between 2000 and 2020 by oncological femoral or tibial resection followed, at a distance from adjuvant chemotherapy, by reconstruction using the induced-membrane technique. Non-union was the primary outcome measure and the MusculoSkeletal Tumor Society (MSTS) lower-limb functional score was the secondary outcome measure. Mean follow-up was 6.1 years (range, 2.0-12.7). At last follow-up, mean age was 18.1 years (range, 11.0-26.0) and the mean MSTS score was 66.6% (37.0-93.0%). RESULTS After the second reconstruction stage, 8 complications developed in 6 patients (46%). Either a complication or limb-length inequality required 12 re-operations in 8 patients (61.5%). Non-union occurred after reconstruction in 5 (38.5%) patients. Early resumption of 50% weight-bearing 6 weeks after reconstruction was associated with bone healing (p=0.02). CONCLUSION The non-union rate was 38.5%. Partial, 50% weight-bearing with two elbow crutches and an orthosis, if allowed by construct stability, may promote bone healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Thibault Marty-Diloy
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Pierre Mary
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Vialle
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculo-squelettiques, université de la Sorbonne, Paris, France
| | - Franck Fitoussi
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphael Pietton
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Service de chirurgie orthopédique et traumatologique, hôpital Pitié Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Tristan Langlais
- Service de chirurgie orthopédique et traumatologique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département d'orthopédie pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France.
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Alonso E, Victoria C, Touati N, Vialle R, Fitoussi F, Bachy M. Computer aided multiplanar osteotomy using patient specific instrumentation to treat cubitus varus in children. Orthop Traumatol Surg Res 2023:103808. [PMID: 38159639 DOI: 10.1016/j.otsr.2023.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Cubitus varus deformity is a common complication of supracondylar fractures in children. Anatomic correction is the key to obtaining good functional results and avoiding later symptomatic degradation. Different techniques have been described, mainly lateral closing wedge osteotomy. A medial opening wedge osteotomy seems more intuitive, allowing an anatomic reduction, but it is technically challenging. Two-plane radiographs are too simplistic to appreciate the 3D deformity. With medical imaging and image processing advances, three-dimensional (3D) virtual models of a patient's anatomy can be generated. Rapid 3D printing has allowed virtual simulations of surgical corrections to be transferred to real-world applications in the operating room, allowing more precise and accurate surgery with better 3D corrections. 3D computer modeling with the development of customized drilling and cutting guides allows complex medial opening wedge osteotomy for correction of cubitus varus deformity in immature children with best-fit plate synthesis. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Estelle Alonso
- Service de chirurgie orthopédique et réparatrice de l'enfant, Sorbonne Université, AP-HP, Hôpital Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - Christian Victoria
- Hospital for Special Surgery, Hand and Upper Extremity Service, New York, NY, USA
| | - Nizar Touati
- Service de chirurgie orthopédique et réparatrice de l'enfant, Sorbonne Université, AP-HP, Hôpital Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - Raphael Vialle
- Service de chirurgie orthopédique et réparatrice de l'enfant, Sorbonne Université, AP-HP, Hôpital Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - Franck Fitoussi
- Service de chirurgie orthopédique et réparatrice de l'enfant, Sorbonne Université, AP-HP, Hôpital Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; STREAM, CRMR Site Trousseau enfant anomalie des membres, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - Manon Bachy
- Service de chirurgie orthopédique et réparatrice de l'enfant, Sorbonne Université, AP-HP, Hôpital Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; STREAM, CRMR Site Trousseau enfant anomalie des membres, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; UMR CNRS 7052, Inserm U1271, Université de Paris, B3OA, 10, avenue de Verdun, 75010 Paris, France.
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Fleurette J, Atlan M, Legagneux J, Fitoussi F. Training in microvascular anastomosis - A randomized comparative study between chicken thigh specimen and live rat. Hand Surg Rehabil 2023; 42:499-504. [PMID: 37598858 DOI: 10.1016/j.hansur.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
Training in microsurgical techniques on live rats is the gold standard, but raises ethical issues related to animal welfare and cost. The aim of this study was to compare acquisition of microsurgical techniques with primary training on chicken thigh specimens. Seventy six students were randomly assigned: 23 to exclusive rat training and 53 to primary chicken-leg training. Both groups were then evaluated on aortic suture and jugular aortic bypass surgery in live rats. The primary criterion for successful anastomosis was the patency test. The survival of the rat, the number of severe vascular wounds and the quality of the dissection were also assessed. Aortic anastomoses were of significantly better quality in the chicken group (p = 0.041). There was no significant difference in the number of serious injuries, rat mortality, or quality of dissection (p > 0.05). For jugular aortic bypass surgery, dissection quality (p = 0.02) and patency test (p = 0.05) were better in the chicken-leg group. There was no significant difference in number of severe wounds or rat mortality (p > 0.05). Students who started their microsurgical training on a chicken leg did not perform worse than those with exclusive live rat training. Initial training on chicken thigh specimens seems to be a reliable alternative to training on live models. LEVEL OF EVIDENCE: Level II - Randomized controlled trial.
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Affiliation(s)
- Justine Fleurette
- Université de Versailles Saint-Quentin-en-Yvelines, Service de Chirurgie Orthopédique et Traumatologique, AP-HP, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - Michael Atlan
- Sorbonne Médecine Université, Service de Chirurgie Plastique Reconstructrice et Esthétique, AP-HP, Hôpital Tenon, 75020 Paris, France; Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France
| | - Josette Legagneux
- Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France
| | - Franck Fitoussi
- Sorbonne Médecine Université, Département de Microchirurgie, AP-HP, 75005 Paris, France; Sorbonne Médecine Université, Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, AP-HP, Hôpital Trousseau, 75012 Paris, France.
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Langlais T, Louis E, Badina A, Vialle R, Pannier S, Le Hanneur M, Fitoussi F. "Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes. J Child Orthop 2023; 17:581-589. [PMID: 38050602 PMCID: PMC10693846 DOI: 10.1177/18632521231211643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Background The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury). Methods A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up. Results Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%. Conclusion The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations. Level of evidence level III.
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Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Purpan Children Hospital, Toulouse University, Toulouse, France
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Emmanuelle Louis
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Alina Badina
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
| | - Raphael Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
| | - Stéphanie Pannier
- Department of Pediatric Orthopedics, Necker Hospital, Paris Cité University, Paris, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, Marseille, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, Paris, France
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Payen M, Didier M, Vialle R, Lehericy S, Fitoussi F, Bachy M. MRI of brachial plexus using diffusion tensor imaging: a pilot study for the use of resolve sequence surgical and radiologic anatomy. Surg Radiol Anat 2023; 45:1567-1577. [PMID: 37884742 DOI: 10.1007/s00276-023-03255-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Clinical exam is the goldstandard for surgical indication. ENMG and conventional MRI are insufficient to understand the highly variable clinical presentation of brachial plexus (BP) lesions. DTI is based on motion of water molecules and can explore nerve function. PURPOSE This pilot study of healthy subjects aimed to develop RESOLVE sequence for BP exploration using diffusion MRI. The main objective was to provide complete precise information from DTI cartography associated with anatomical data. METHODS Six healthy volunteers were scanned using 3T PRISMA scanner with anatomic 3D STIR SPACE and RESOLVE diffusion sequences. Diffusion parametric maps of fractional anisotropy (FA) were extracted from RESOLVE acquisitions. A reproducible method for roots volumes and angles measurements was created using 3DSlicer. ROI were segmented on Mean B0 sequences. FA measurements were obtained with ROI on Mean B0 sequences. RESULTS RESOLVE sequence was adapted to the BP. Mean FA was 0.30. Angles measurements on 3D STIR SPACE sequences showed increasing values from proximal to distal roots with an 0.6 ICC. Volume measurements on anatomic sequences varied widely from one root to another but did not show any significant difference on laterality. CONCLUSIONS A new and reproducible method for BP exploration was developed, using MRI RESOLVE DTI sequences. Complete mapping was obtained but a low resolution of track density imaging did not allow to exploit distal nerves. Deterministic tractography principal limit was the lack of resolution. Extraction of diffusion, volumetric and angular parameters of the plexus roots, and scripts creation for image processing was adapted to the healthy BP.
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Affiliation(s)
- M Payen
- Clinique Chirurgicale Infantile, Hôpital Charles-Nicolle, CHU Rouen, 37 Boulevard Gambetta, 76038, Rouen, France.
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France.
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
| | - M Didier
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
| | - R Vialle
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - S Lehericy
- Paris Brain Institute-ICM, Center for NeuroImaging Research-CENIR, Paris, France
- Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS, UMR 7225, Pitié-Salpêtrière Hospital, Paris, France
- Investigations and Therapeutics" (MOV'IT), ICM Team "Movement, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
| | - M Bachy
- Department of Pediatric Orthopaedics, Sorbonne Université, Armand Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France
- Clinical Research Group on Robotics and Surgical Innovations, GRC-33, Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
- The MAMUTH Hospital-University Federation for Innovative Therapies in Musculoskeletal Diseases-Sorbonne Université, Armand Trousseau Hospital, 26, Avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France
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Dukan R, Lacroix M, Bertin E, Reverdito G, Fitoussi F, Binder AC. Acute digit ischemia due to a ruptured digital collateral artery aneurysm in a patient of hemophilia: A case report. J Orthop Case Rep 2023; 13:70-74. [PMID: 38025357 PMCID: PMC10664232 DOI: 10.13107/jocr.2023.v13.i11.4010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/29/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Digital artery aneurysms are a rare event but cases have been reported in the literature. The hemostasis disorders make these aneurysms particularly dangerous with potentially irreversible hand complications: Compression of adjacent vascular and nervous structures, embolization of associated thrombi, finger ischemia, and necrosis. Case Report We reported a case of digital ischemia due to a ruptured aneurysm of a digital collateral artery, leading to the diagnosis of congenital hemophilia A. Hematoma evacuation allowed finger revascularization. Complete symptom resolution required ligature excision associated with Factor VIII supplementation. Conclusion Aneurysms of the digital collateral arteries are a rare event. In the case of a hemophilic patient, surgical management is necessary, and medical treatment alone is not sufficient. The consequences of a ruptured aneurysm in this type of patient can be serious. A close monitoring is required to ensure the absence of early recurrence.
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Affiliation(s)
- Ruben Dukan
- Department of Orthopedic Surgery, Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Maxime Lacroix
- Department of Radiology, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emilie Bertin
- Department of Orthopedic Surgery, Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Guillaume Reverdito
- Department of Radiology, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Sorbonne University, Paris, France
| | - Adeline Cambon Binder
- Department of Orthopedic and Hand Surgery, Sorbonne University, Saint Antoine Hospital, Paris, France
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Le Hanneur M, Brahim L, Langlais T, Bouché PA, Fitoussi F. Age Influence Upon Glenohumeral Remodeling After Shoulder Axial Rebalancing Surgery in Brachial Plexus Birth Injury. J Pediatr Orthop 2023; 43:e389-e395. [PMID: 36882889 DOI: 10.1097/bpo.0000000000002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Shoulder rebalancing procedures have been proven to provide satisfactory functional improvements in patients with shoulder external rotation (ER) deficit due to brachial plexus birth injury (BPBI). However, the influence of age at the time of surgery on osteoarticular remodeling remains uncertain. The purposes of this retrospective case series were (1) to assess the age impact on glenohumeral remodeling and (2) to determine an age limit after which significant changes can no longer be expected. METHODS We reviewed preoperative and postoperative magnetic resonance imaging data of 49 children with BPBI who underwent a tendon transfer to reanimate active shoulder ER, with (n=41) or without (n=8) concomitant anterior shoulder release to restore passive shoulder ER, at a mean age of 72 ± 40 months (19;172). Mean radiographic follow-up was 35 ± 20 months (12;95). Univariate linear regressions were used to assess the influence of age at the time of surgery upon changes of glenoid version, glenoid shape, percentage of the humeral head anterior to the glenoid midline, and glenohumeral deformity. Beta coefficients with 95% CI were calculated. RESULTS Improvements of glenoid version, glenoid shape, percentage of the humeral head anterior and glenohumeral deformity significantly decreased by 0.19 degrees [CI=(-0.31; -0.06), P =0.0046], 0.02 grade [CI=(-0.04; -0.01), P =0.002], 0.12% [CI=(-0.21; -0.04), P =0.0076], and 0.01 grade [CI=(-0.02; -0.01), P =0.0078] per additional month of age at the time of surgery, respectively. The threshold of 5 years was identified as the age at the time of surgery after which significant remodeling no longer occurred. No significant postoperative changes were observed in patients without glenohumeral dysplasia on preoperative magnetic resonance imaging. CONCLUSION In the setting of BPBI-related glenohumeral dysplasia, the younger the surgical axial rebalancing of the shoulder, the greater the glenohumeral remodeling seems to be. Such procedure seems to be safe in patients without significant joint deformity on preoperative imaging. LEVEL OF EVIDENCE Therapeutic-Level IV.
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Affiliation(s)
- Malo Le Hanneur
- Department of Pediatric Orthopedics and Reconstruction, Armand Trousseau Hospital-Sorbonne University, Paris
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, France
| | - Lilia Brahim
- Department of Pediatric Orthopedics and Reconstruction, Armand Trousseau Hospital-Sorbonne University, Paris
| | - Tristan Langlais
- Department of Pediatric Orthopedics and Reconstruction, Armand Trousseau Hospital-Sorbonne University, Paris
| | - Pierre-Alban Bouché
- Department of Pediatric Orthopedics and Reconstruction, Armand Trousseau Hospital-Sorbonne University, Paris
| | - Franck Fitoussi
- Department of Pediatric Orthopedics and Reconstruction, Armand Trousseau Hospital-Sorbonne University, Paris
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Langlais T, Barret H, Le Hanneur M, Fitoussi F. Dynamic pediatric shoulder instability: Etiology, pathogenesis and treatment. Orthop Traumatol Surg Res 2023; 109:103451. [PMID: 36273504 DOI: 10.1016/j.otsr.2022.103451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 11/05/2022]
Abstract
Dynamic shoulder instability in children or adolescents, whose glenohumeral growth plates are still open, is a rare condition with an etiology that is hard to decipher. Atraumatic and recurrent forms are most common, contrary to adults. Disruptions to capsule and ligament maturation, muscle balance or bone growth can lead to glenohumeral instability. The etiology assessment, which needs to be multidisciplinary in atraumatic forms, aims to collect the medical history, analyze the direction of the instability, determine whether it is voluntary or involuntary, and look for a history of trauma, connective tissue abnormality, psychological disorder, neuromuscular pathology or congenital malformation. The initial treatment is conservative. It requires a multidisciplinary team when the shoulder instability is voluntary. Surgical treatment is reserved for symptomatic forms that do not respond to conservative treatment and have an impact on daily life and/or sports participation after a minimum of 6 months of well-conducted rehabilitation. The results of surgical stabilization mainly depend on the features of the instability, the anatomical structures damaged and the etiology. Episodes of recurrent instability in children/adolescents with open glenohumeral growth plates can fade in adulthood or can get worse with the development of structural damage. Early detection of poor outcomes and suitable treatment will help to limit the occurrence of osteoarthritis in the medium and long term. LEVEL OF EVIDENCE: Expert opinion.
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Affiliation(s)
- Tristan Langlais
- Hôpital des enfants, Purpan, Toulouse université, Toulouse, France; Service orthopédie infantile, Necker-Enfants-Malades, université de Paris, Paris, France.
| | - Hugo Barret
- Département orthopédie adulte, Purpan, Toulouse université, Toulouse, France
| | - Malo Le Hanneur
- Centre main épaule Méditerranée, ELSAN, clinique Bouchard, Marseille, France; Service orthopédie infantile, Armand Trousseau, Sorbonne université, Paris, France
| | - Franck Fitoussi
- Service orthopédie infantile, Armand Trousseau, Sorbonne université, Paris, France
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Moulinier C, Bellity-Nahmani L, Saghbiny E, Bachy-Razzouk M, Bouché PA, Fitoussi F. Corrélation entre l’évaluation anatomopathologique des recoupes nerveuses et la récupération motrice dans les paralysies néonatales du plexus brachial. Hand Surgery and Rehabilitation 2022. [DOI: 10.1016/j.hansur.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Le Hanneur M, Chaves C, Lauthe O, Salabi V, Bouché PA, Fitoussi F. Conventional versus fibrin-glue-augmented arterial microanastomosis: An experimental study. Hand Surg Rehabil 2022; 41:569-575. [PMID: 35988913 DOI: 10.1016/j.hansur.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
The purpose of this experimental study was to develop an alternative technique of arterial microanastomosis using only 2 stay-sutures augmented with fibrin glue, and to compare it to the conventional technique in arteries of varying diameters mimicking hand arteries. Eight anastomoses were performed in 7 male rats, including 1 anastomosis each on the 2 femoral, iliac, and carotid arteries, and 2 on the subrenal aorta. The conventional technique was used on one side and on the first aorta anastomosis, while augmented anastomoses were performed on the other side and on the second aorta. Patency was tested 10 min after unclamping; clamping time, blood loss, anastomosis quality score (out of 15 points) and artery diameter were recorded. In arteries of diameter 0.5-2.2 mm, augmented anastomoses were on average 10.7 ± 3.2 min faster to perform (p < 0.0001), with an average of 1.3 ± 0.9 g less blood loss (p < 0.0001) and an average of 2.6 ± 2.5 points higher quality score (p < 0.0001). There were no significant differences between the two techniques in terms of patency rate, regardless of artery size. However, 3 of the 7 augmented anastomoses were non-permeable in the femoral subgroup (i.e., submillimetric arteries). This straightforward technique appears to be time-saving and reliable, provided that the repaired artery is of sufficient size. Subject to clinical validation, this technique might help surgeons treating extensive hand wounds with multiple severed neurovascular bundles.
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Affiliation(s)
- M Le Hanneur
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France; Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
| | - C Chaves
- Unité de Chirurgie de la Main, Clinique du Pré, 13 avenue René Laennec, 72000 Le Mans, France.
| | - O Lauthe
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France.
| | - V Salabi
- Hand to Shoulder Mediterranean Center, ELSAN, Clinique Bouchard, 77 rue du Dr Escat, 13006 Marseille, France.
| | - P-A Bouché
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne University, 26 avenue du Dr Arnold Netter, 75012 Paris, France.
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12
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Benayoun M, Langlais T, Laurent R, Le Hanneur M, Vialle R, Bachy M, Fitoussi F. 3D planning and patient-specific surgical guides in forearm osteotomy in children: Radiographic accuracy and clinical morbidity. Orthop Traumatol Surg Res 2022; 108:102925. [PMID: 33845175 DOI: 10.1016/j.otsr.2021.102925] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Three-dimensional (3D) planning and patient-specific surgical guides are increasingly used in the treatment of skeletal deformities. The present study hypothesis was that they are reliable in forearm osteotomy in children, with low morbidity. MATERIAL AND METHODS Twenty-there children with one or several osteotomies to correct forearm deformities were retrospectively included: 9 (20 osteotomies) with surgical guide (G+), and 14 (28 osteotomies) without (G-). Etiologies comprised 8 cases of Madelung disease (3G+, 5G-) and 15 of post-traumatic malunion (6G+, 9G-). Mean age at surgery was 14.8±1.9 years. The patient-specific 3D-printed polyamide guides were produced from 3D virtual models based on 3D CT reconstruction. Mean follow-up was 22.1±13.6 months. RESULTS Mean correction error was 5.3°±4.1 and 4.2°±4.1 in the frontal and sagittal planes respectively in G+ (p=0.6). Surgery time was significantly shorter in G+, by a mean 42min (p=0.02). Mean total radiation dose (preoperative CT+intraoperative fluoroscopy) was significantly higher in G+ (p<0.0001). Complications rates were similar between groups. Improvement in PRWE score was significantly greater in G+. CONCLUSION The present preliminary results were encouraging. 3D planning and patient-specific surgical guides can be used in the treatment of forearm deformity in children. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Marie Benayoun
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Tristan Langlais
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants Purpan, Université de Toulouse, Toulouse, France.
| | - Romain Laurent
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Malo Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Raphaël Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Département des Maladies Musculo-Squelettiques et Innovations Thérapeutiques, Sorbonne Université, Paris, France
| | - Manon Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Franck Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Département des Maladies Musculo-Squelettiques et Innovations Thérapeutiques, Sorbonne Université, Paris, France
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Boccara O, Dangien A, Fitoussi F, Ducou Le Pointe H, Coulomb L'Hermine A, Fraitag S, Lorrot M. Bone kaposiform hemangioendothelioma: A rare entity dramatically improved by sirolimus. J Paediatr Child Health 2022; 58:1676-1679. [PMID: 35138010 DOI: 10.1111/jpc.15897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Olivia Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris, Paris-Centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Ambre Dangien
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris, Paris-Centre, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Franck Fitoussi
- Department of Orthopedic Surgery, Hôpital Universitaire Trousseau, Sorbonne Université, APHP, Paris, France
| | | | | | - Sylvie Fraitag
- Department of Pathology, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Mathie Lorrot
- Department of Pediatrics, Hôpital Universitaire Trousseau, Sorbonne Université, APHP, Paris, France
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Le Hanneur M, Langlais T, Fitoussi F. Management of a severe radial longitudinal deficiency using a magnetically controlled growing rod. J Hand Surg Eur Vol 2022; 47:527-529. [PMID: 34633884 DOI: 10.1177/17531934211051289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Malo Le Hanneur
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne Université, Paris, France.,Hand to Shoulder Mediterranean Center, ELSAN, Marseille, France
| | - Tristan Langlais
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne Université, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand Trousseau Hospital - Sorbonne Université, Paris, France
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Dukan R, Le Hanneur M, Pannier S, Fitoussi F. Use of an external fixator during one-step surgical management of missed chronic Monteggia injuries. Orthop Traumatol Surg Res 2022; 108:102963. [PMID: 34022463 DOI: 10.1016/j.otsr.2021.102963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
The incidence of untreated Monteggia fracture-dislocations is not insignificant. But there is no consensus as to the surgical indication and best surgical technique to use. Single-stage reduction of the radial head through an elbow arthrotomy and ulnar osteotomy is a complex surgical procedure that requires stabilization of the ulnar segments during every step of the intervention. Here, we describe the possibility of using an external fixator intraoperatively to facilitate the various steps of the procedure: (1) gradual distraction and angulation of the osteotomy site to allow thorough excision of any interposed capsular tissue, (2) stable hold on the ulnar fragments independent of the surgical assistant, which allows the stability of the radial head reduction to be tested in pronation and supination and (3) facilitation of plate fixation at the ulnar osteotomy site. LEVEL OF EVIDENCE: IV; case series.
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Affiliation(s)
- Ruben Dukan
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, hôpital Trousseau, Université Sorbonne, Paris, France.
| | - Malo Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, hôpital Trousseau, Université Sorbonne, Paris, France
| | - Stéphanie Pannier
- Service de Chirurgie Orthopédique Pédiatrique, hôpital Necker, Université Paris V, Paris, France
| | - Franck Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, hôpital Trousseau, Université Sorbonne, Paris, France
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Langlais T, Rougereau G, Marty-Diloy T, Bachy M, Barret H, Vialle R, Fitoussi F. Surgical treatment in child's congenital toe syndactyly: Risk factor of recurrence, complication and poor clinical outcomes. Foot Ankle Surg 2022; 28:107-113. [PMID: 33642221 DOI: 10.1016/j.fas.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Surgical treatment of toe syndactyly remains controversial. The strong demand from parents for a cosmetic release is increasing in our societies. But is it worth it? The objective was to assess medium-long term outcomes and to identify the risk factors of recurrence, complication and poor clinical outcomes. METHODS Sixty-eight toe syndactylies (38 patients) undergoing surgery between 2008 and 2017 with a follow-up higher than two years were included consecutively and retrospectively. Four children (four syndactylies) were lost to follow-up and excluded. The mean age of the first surgery was 3.9 years old (0.8-16.7) and cohort mean follow-up was 6.9 years (2.8-11.2). In all patients, web release with a commissural dorsal flap was performed and associated a cutaneous resurfacing (spontaneous epithelialization, full-thickness skin graft taken from the popliteal crease, or a hyaluronic acid ester matrix). RESULTS Eighteen syndactylies (28.1%) in 14 patients recurred and one syndactyly required revision surgery. An age of surgery above two years was the only risk factor for recurrence found in univariate (OD = 0.27[0.08;0.85];p = 0.02) and multivariate studies (IC 95% = 0.05-0.68;p = 0.02). Seven complications (11.7%) in seven syndactylies (6 patients) were reported with six keloids (9.4%) and one scar retraction (1.6%). Each complication underwent an additional procedure. African ethnicity (N = 15) represents a risk factor (N = 4/15; OD = 0.12[0.009;0.97];p = 0.02) for keloids formation. Withey's average score is 4.9 (1-11), mean OxAFQ-C score was 52/60 (30-60), 67% would repeat the surgery and 69% felt satisfied at last follow-up. The simple syndactyly would appear less satisfied than complex or complicated (p = 0.02). CONCLUSIONS Surgical treatment of child's congenital syndactyly involves a risk of recurrence (28%) and potential complications (11,7%). Performed surgical procedure over two years old increase the risk of recurrence. African ethnicity is a risk factor in scarring complication. Only half of simple syndactylies are satisfied and prone to repeat the surgery.
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Affiliation(s)
- Tristan Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; Children's Hospital, Purpan, Toulouse University, Toulouse, France.
| | - Gregoire Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Hugo Barret
- Orthopedics Department, Purpan, Toulouse University, Toulouse, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr-Arnold-Netter, 75012 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
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17
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Rougereau G, Fitoussi F, Marty-Diloy T, Bachy M, Vialle R, Langlais T. Strategy and clinical outcomes of child foot surgery for macrodactyly. Orthop Traumatol Surg Res 2021; 109:103109. [PMID: 34648998 DOI: 10.1016/j.otsr.2021.103109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Amputation of the abnormal segment seems to be the reference standard treatment for the surgical management of macrodactyly of the foot in children. Our objectives here were to detail the surgical strategies according to the cause, anatomical characteristics, and static or progressive nature of the macrodactyly and to evaluate the long-term clinical outcomes. HYPOTHESIS Conservative treatment can be an option in the management of static macrodactyly of the foot in children. MATERIAL AND METHODS We retrospectively included 24 feet in 19 patients seen consecutively. There were 12 primary and 12 secondary types. The macrodactyly was static in 9 cases and progressive in 15 cases. The treatment consisted in either conservative procedures or amputation of the segment. All patients completed the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) to evaluate their quality of life, shoe wear issues, and satisfaction with their treatment. RESULTS Mean age at first surgery was 5.8 years (range, 0.5-11.5) and the mean interval between two procedures was 2.3 years (range, 0.3-5.5). Mean number of procedures per foot was 2.2 par pied (range, 0-7). All 9 static forms were managed conservatively. Amputation was performed in 11 of the 15 progressive forms. The mean number of procedures was significantly higher in the progressive forms (4.1 vs. 1.5/pied; p=0.006). Two patients died during follow-up. The remaining 17 patients, with 22 affected feet (primary and secondary in 11 cases; progressive in 14 cases and static in 8 cases) were re-evaluated. Mean follow-up was 9.4 years (range, 2.7-20.6). The final OxAFQ-C score was 46/60 (range, 18-58). Of the 17 patients, 86% would be willing to repeat the same surgical procedures and 77% were satisfied with their treatment at last follow-up. We found no differences between the groups managed with amputation and with conservative treatment regarding quality of life, satisfaction, or shoe size difference. CONCLUSIONS Conservative treatment deserves a place in the treatment of static macrodactyly of the foot in children. Regarding amputation of the segment in progressive forms, it is important to reassure the patients and parents about the expected results but also to inform them about the risk of requiring repeat surgical procedures. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Gregoire Rougereau
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département de chirurgie orthopédique, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
| | - Franck Fitoussi
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Thibault Marty-Diloy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Manon Bachy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Raphaël Vialle
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département universitaire MAMUTH des thérapies innovantes en matière de maladies musculo-squelettiques, Paris, France
| | - Tristan Langlais
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Hôpital des enfants, Purpan, Toulouse université, Toulouse, France.
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18
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Bachy M, Victoria C, Martinot-Lagarde C, Romana C, Vialle R, Fitoussi F. Global assessment of pollicization outcomes: an analysis in 27 patients. J Hand Surg Eur Vol 2021; 46:754-761. [PMID: 33789509 DOI: 10.1177/17531934211003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Outcomes measurements after pollicization remains difficult due to the lack of a standardized assessment protocol. This study reports our experience of a global assessment of pollicized thumbs that includes a specific questionnaire for subjective evaluation, a detailed clinical assessment focused on functional outcomes incorporating function and usage of the pollicized thumb. Twenty-seven patients completed the questionnaire, and nine hands were clinically evaluated by a multidisciplinary team composed of hand surgeons and occupational therapists. Subjective evaluations revealed that 24 patients would recommend pollicization. Clinical evaluations revealed that only four out of nine patients properly integrated their pollicized thumb during bimanual activities; however, occupational therapy input allowed the children to compensate for the lack of strength and other difficulties. We propose the use of this global assessment package to analyse function and usage at various capacities, which can be useful for the surgeon, child and parents.Level of evidence: IV.
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Affiliation(s)
- Manon Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Sorbonne Université - Hôpital Trousseau APHP, Paris, France.,Centre de référence Malformation des Membres CEREFAM, Hôpital National de Saint Maurice, Saint-Maurice, France
| | - Christian Victoria
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA
| | - Coline Martinot-Lagarde
- Centre de référence Malformation des Membres CEREFAM, Hôpital National de Saint Maurice, Saint-Maurice, France
| | - Claudia Romana
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Sorbonne Université - Hôpital Trousseau APHP, Paris, France.,Centre de référence Malformation des Membres CEREFAM, Hôpital National de Saint Maurice, Saint-Maurice, France
| | - Raphael Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Sorbonne Université - Hôpital Trousseau APHP, Paris, France
| | - Franck Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Sorbonne Université - Hôpital Trousseau APHP, Paris, France.,Centre de référence Malformation des Membres CEREFAM, Hôpital National de Saint Maurice, Saint-Maurice, France
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Maurel N, Diop A, Lallemant-Dudek P, Fitoussi F. Upper limb kinematics after Latissimus Dorsi transfer in children with brachial plexus birth palsy. Clin Biomech (Bristol, Avon) 2021; 87:105413. [PMID: 34174673 DOI: 10.1016/j.clinbiomech.2021.105413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Brachial plexus birth palsy remains a frequent condition and one of its treatments is to transfer the Latissimus Dorsi tendon to the infraspinatus muscle. The aim of this study was to analyse, for the first time, the three-dimensional kinematic effects of this operation on the upper limb joints during the five Mallet tasks and their correlation with clinical parameters. METHODS Kinematic analysis was performed using an electromagnetic device. An Index of Improvement taking into account the angle in preop and postop, the reproducibility and the angle of a control group was developed. Three groups of patients were analysed: sixteen patients (mean: 10,5 years) for the reproducibility, thirty children (mean: 9,5 years) for the control group and ten patients (mean: 8 years 7 months) who were operated. FINDINGS The humerothoracic and glenohumeral external rotations improved during the external rotation, the neck and the abduction tasks and worsened during the spine task. The glenohumeral external rotation worsened during the mouth task. The Humerothoracic abduction improved during the abduction and the neck tasks. The elbow flexion improved for the neck task. Differences were observed between patients and correlations were obtained between the Index of Improvement and clinical parameters. INTERPRETATION Using kinematics allows to better analyse the evolution of joint angles after the latissimus dorsi transfer. The Index of Improvement allows to quickly analyse the effect of the operation for each angle and each patient. This effect depends on clinical parameters.
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Affiliation(s)
- Nathalie Maurel
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Amadou Diop
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Pauline Lallemant-Dudek
- Hôpital Trousseau, Service de Médecine Physique et de Réadaptation pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Faculté de Médecine Sorbonne Université, 91 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Franck Fitoussi
- Hôpital Trousseau, Service de chirurgie orthopédique et reconstructrice de l'enfant, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Faculté de Médecine Sorbonne Université, 91 Boulevard de l'Hôpital, 75013 Paris, France.
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20
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Rougereau G, Marty-Diloy T, Pietton R, Koneazny C, Fitoussi F, Vialle R, Mary P, Langlais T. Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases. Hand Surg Rehabil 2021; 40:799-803. [PMID: 34171528 DOI: 10.1016/j.hansur.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.
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Affiliation(s)
- G Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Koneazny
- The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - P Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, 330 Avenue de Grande Bretagne, 31300 Toulouse, France.
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Bachy M, Lallemant P, Grimberg J, Fitoussi F. Palliative shoulder and elbow surgery in obstetrical brachial plexus birth palsy. Hand Surg Rehabil 2021; 41S:S63-S70. [PMID: 34058395 DOI: 10.1016/j.hansur.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Palliative surgery in a child with incomplete recovery following obstetric brachial plexus birth palsy (BPBP) is common. Surgical management strategies for BPBP sequelae have the common objectives of decreasing the risk of functional limitations in the long term and improving function. There is no single treatment to deal with the sequelae of BPBP. While there is a myriad of possible clinical presentations, the ages for surgery extend from a 6- to 12-month-old infant to the mature adolescent. Numerous procedures have been described in the literature, ranging from simple soft tissue release to muscular transfers and osteotomies. The indications will depend on a combination of all these factors. In certain cases, an early intervention is recommended to prevent joint deformities, and to allow joint remodeling, often at the shoulder. In other cases, the indications are less clear, thus the expected benefit must be carefully considered. The indications for these operations must meet certain rules to be beneficial for the patient and should only be considered after a comprehensive clinical examination and a commitment from the child and the family to the therapeutic strategy.
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Affiliation(s)
- M Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - P Lallemant
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
| | - J Grimberg
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, APHP, 26, Avenue du Dr Arnold Netter, 75012 Paris, France
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Allard R, Fitoussi F, Azarpira MR, Bachy M, Grimberg J, Le Hanneur M. Shoulder internal rotation contracture in brachial plexus birth injury: proximal or distal subscapularis release? J Shoulder Elbow Surg 2021; 30:1117-1127. [PMID: 32853791 DOI: 10.1016/j.jse.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND In cases of brachial plexus birth injury with internal rotation contracture of the shoulder, the subscapularis muscle may be released proximally, from the subscapular fossa, or distally, along with periarticular soft tissues arthroscopic to the glenohumeral joint. We hypothesized that the indication for each procedure would rely primarily on patients' bone remodeling potential and periarticular soft-tissue contractures, performing proximal releases in patients aged < 4 years and periarticular distal releases in older patients. The purpose of this study was to analyze the outcomes such a strategy could provide. METHODS All patients presenting with brachial plexus birth injury-related shoulder internal rotation contractures who underwent a subscapularis release were included; in addition, to restore the joint axial balance, the infraspinatus was systematically reanimated with a tendon transfer (ie, latissimus dorsi or lower trapezius) during the same operating time. Chart review yielded preoperative and postoperative clinical and radiographic measurements, including active and passive range of motion of the shoulder in external rotation (ER) with the arm at the side of the body, the modified Mallet score, glenoid version, and the percentage of the humeral head arthroscopic to the middle of the glenoid process. RESULTS Between July 2012 and January 2018, 28 children were operated on at our institution. In patients who underwent proximal subscapularis release (n = 13), significant improvements were observed regarding active shoulder ER, passive shoulder ER, the modified Mallet score, glenoid version, and the percentage of the humeral head arthroscopic to the middle of the glenoid process, averaging 58° ± 32° (P < .0001), 56° ± 20° (P < .0001), 9.7 ± 3.1 points (P = .0006), 15° ± 10° (P = .0034), and 24% ± 20% (P = .0113), respectively, after a mean follow-up period of 4 years. Following distal release procedures (n = 15), these improvements averaged 26° ± 29° (P = .0024), 27° ± 28° (P = .0011), 3.3 ± 4.1 points (P = .0049), 2° ± 17° (P = .4086), and 4% ± 18% (P = .215), respectively, after a mean follow-up period of 3 years. CONCLUSION When combined with axial rebalancing of the joint, the proximal release of the subscapularis muscle appears to be sufficient to provide satisfactory functional outcomes in patients with great bone remodeling potential and supple periarticular soft tissues. In older patients, a more comprehensive release of the glenohumeral joint's arthroscopic aspect seems to provide lower but still significant clinical improvements.
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Affiliation(s)
- Romain Allard
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Mohammad Reza Azarpira
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France
| | - Jean Grimberg
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France; Department of Orthopedic Surgery, Clinique Jouvenet-Ramsay-Générale de Santé, Paris, France; Institute of Research in Orthopedics and Sports Surgery (IRCOS), Paris, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopedics, Armand Trousseau Hospital-Sorbonne University, Paris, France.
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Bebing M, de Courtivron B, Pannier S, Journeau P, Fitoussi F, Morin C, Violas P. Madelung's deformity in children: Clinical and radiological results from a French national multicentre retrospective study. Orthop Traumatol Surg Res 2020; 106:1339-1343. [PMID: 32962949 DOI: 10.1016/j.otsr.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Madelung's deformity is rare. Treatment often consists in radial or ulnar osteotomy, Vickers' ligament resection or ulnar epiphysiodesis. The present multicenter retrospective study reports clinical and radiographic results in various surgeries. The study hypothesis was that early surgery improves outcome. MATERIAL AND METHOD Files were analyzed for 36 children (47 wrists) operated on between 1998 and 2015. Mean age at diagnosis was 12 years (range, 6-15 years). Mean follow-up was 7.2 years (range, 2-17.4 years). Two age groups were distinguished: 6-11 and 12-17 years. Endpoints were esthetic, functional (Mayo Wrist Score: MWS) and radiographic [lunate fossa angle (LFA), radial height (RH), lunatum cover rate (LCR), ulnar head translation (UHT), lunatum ascension (LA)]. Techniques mainly comprised distal radius osteotomy (DRO) with ulnar shortening osteotomy (USO), and Vickers' ligament resection (VR), either isolated or associated to osteotomy. RESULTS Age at surgery guided choice of technique, but did not impact results. VR gave better functional results when performed in young children; it was mainly performed in the 6-11 years age group, providing very satisfactory results (7 out of 8 wrists) with excellent function (7 out of 8), without improving radiographic parameters; in the 12-17 years age group, even when esthetic results were excellent, functional results were only good-to-acceptable (3 out of 5 wrists) and 1 result was poor. DRO+USO was mainly performed in the 12-17 years age group, with very satisfactory or satisfactory results (8 out of 10 wrists) and excellent function (6 out of 10). DRO+USO appeared to be an option of choice, significantly improving radiographic parameters and correcting the deformity (24.5° improvement in LFA (p=0.0033) and 36.2% improvement in LCR (p=0.0103)). DRO+USO+VR was mainly implemented in the 12-17 years age group, with very satisfactory results (3 out of 4 wrists) and excellent-to-good MWS in most cases (3 out of 4), but without significant radiographic improvement. DISCUSSION Esthetic and functional results were comparable regardless of age, except for VR, which gave better functional results in the 6-11 years age group, but without significant difference. CONCLUSION The present study showed that, regardless of children's age, surgery provided esthetic, functional and radiographic benefit, although no decision-tree could be drawn up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Margaux Bebing
- Service de Chirurgie Pédiatrique, CHU of Rennes, boulevard de Bulgarie, 35203 Rennes, France
| | - Benoît de Courtivron
- Service de Chirurgie Pédiatrique, CHUSO Tours-Clocheville, 49, boulevard Béranger, 37000 Tours. France
| | - Stéphanie Pannier
- Service de Chirurgie Orthopédique Pédiatrique, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Pierre Journeau
- Service d'Orthopédie Infantile, CHU Nancy-Hôpitaux de Brabois, 5, rue du Morvan. 54511 Vandoeuvre-les-Nancy, France
| | - Franck Fitoussi
- Service de Chirurgie Orthopédique et Reconstructrice de l'enfant, Hôpital Universitaire Trousseau, Université Paris-Sorbonne UPMC, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - Christian Morin
- Service de Chirurgie Orthopédique Pédiatrique, Institut Calot-Fondation Hopale, rue du Dr-Calot, 62608 Berck, France
| | - Philippe Violas
- Service de Chirurgie Pédiatrique, CHU of Rennes, boulevard de Bulgarie, 35203 Rennes, France.
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Bastard C, Le Hanneur M, Pannier S, Fitoussi F. Radial neck fractures in children secondary to horse-riding accidents: a comparative study. Orthop Traumatol Surg Res 2020; 106:1293-1297. [PMID: 33011108 DOI: 10.1016/j.otsr.2020.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In the pediatric population, fractures of the radial neck account for approximately 1% of all fractures and can have substantial consequences. Given the growing popularity of horse riding and the high-energy traumas that this can entail, we sought to assess prognosis for radial neck fracture sustained in horse riding. HYPOTHESIS Radial neck fracture sustained in horse riding is more severe and more frequently associated with other ipsilateral osteoarticular lesions which worsen prognosis. MATERIAL AND METHOD We performed a multicenter retrospective comparative study in a continuous series of 39 patients. The inclusion criteria consisted of radius neck fracture in children under the age of 15 years. Endpoints comprised associated lesions at time of trauma, and ranges of elbow motion in pronation/supination and flexion/extension at last follow-up. RESULTS Compared to other etiologies, radial neck fractures following horse-riding accidents were more frequently associated with other ipsilateral osteoarticular lesions (p=0.0002), and more often required open reduction (p=0.0409) and postoperative rehabilitation (p=0.041). However, there were no significant differences in any ranges of motion at last follow-up (p>0.05). CONCLUSION Radial neck fractures following horse-riding accidents in children were more severe than those caused by other mechanisms. Awareness campaigns in riding clubs and development of specific protective equipment should be considered to reduce occurrence. LEVEL OF EVIDENCE Therapeutic III - Retrospective comparative study.
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Affiliation(s)
- Claire Bastard
- Department of pediatric orthopedics, Armand Trousseau hospital - Sorbonne university, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Malo Le Hanneur
- Department of pediatric orthopedics, Armand Trousseau hospital - Sorbonne university, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Stéphanie Pannier
- Department of pediatric orthopedics, Necker hospital - Paris-Descartes university, 149, rue de Sèvres, 75014 Paris, France
| | - Franck Fitoussi
- Department of pediatric orthopedics, Armand Trousseau hospital - Sorbonne university, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
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Pfister G, Le Hanneur M, Bachy M, Fitoussi F. Radial club hand treated with soft-tissue distraction and subsequent pin stabilization: mid- to long-term results. J Hand Surg Eur Vol 2020; 45:729-736. [PMID: 32306841 DOI: 10.1177/1753193420916694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radial club hand deformities are commonly treated with arthrolysis to allow centralization of the ulna. In this retrospective cohort study of 31 hands in 28 patients, we aimed to assess the outcomes of correction using progressive distraction and subsequent percutaneous pinning of the wrist with a corrective ulnar osteotomy. Mean follow-up time was 7 years (range 2 to 20). The angulation of the hand-forearm complex was decreased after each step of the procedure. Mean correction of the angulation was 64°, and the residual total forearm-hand angulation was 12° after completion of the surgery. At the time of bony maturity (four patients), all wrists had fused. Fifty-eight reoperations were required in 31 wrists because of pin migration or breakage, and in addition 18 secondary osteotomies of the ulna were performed. From this study we conclude that distraction and pinning provide satisfactory and stable realignment of the wrist to correct the deformity, but this treatment has drawbacks regarding the high number of reoperations and the loss of wrist mobility.Level of evidence: IV.
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Affiliation(s)
- Georges Pfister
- Department of Pediatric Orthopedics, Sorbonne University, Paris, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopedics, Sorbonne University, Paris, France
| | - Manon Bachy
- Department of Pediatric Orthopedics, Sorbonne University, Paris, France
| | - Franck Fitoussi
- Department of Pediatric Orthopedics, Sorbonne University, Paris, France
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Le Hanneur M, Cambon-Binder A, Bachy M, Fitoussi F. Treatment of congenital syndactyly. Hand Surg Rehabil 2020; 39:143-153. [PMID: 32142954 DOI: 10.1016/j.hansur.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 10/24/2022]
Abstract
Defined as the union of two adjacent digits, syndactyly is one of the most common congenital deformities. The severity of the malformation depends on the fusion level, the tissues involved in the union, and whether it is isolated or syndromic. In order to improve the hand's appearance and function, surgery is recommended in the great majority of cases, ideally during early childhood (i.e., before entering school). Web space reconstruction is done using local flaps. Depending on the flap design, digital resurfacing can be done with or without skin grafts. While graftless techniques have shorter operating times and no morbidity associated with skin harvesting, their cosmetic outcomes seem to be worse than those of traditional grafting techniques, with more postoperative complications; furthermore, such techniques cannot be used in all cases, especially those with osteoarticular fusions. When the fingertip is involved, paronychial reconstruction is carried out with pulp flaps. The prognosis for these deformities directly depends on their severity, with excellent outcomes in cases of cutaneous fusion, and much less predictable ones when osteoarticular and/or tendinous tissues are involved.
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Affiliation(s)
- M Le Hanneur
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - A Cambon-Binder
- Service of Hand Surgery, Department of Orthopedics and Traumatology, Saint-Antoine Hospital, Sorbonne University, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - M Bachy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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Le Hanneur M, Pfister G, Bachy M, Pietton R, Vialle R, Fitoussi F. Magnetically controlled growing rods in severe radial club hand congenital deformities. Hand Surg Rehabil 2019; 39:72-74. [PMID: 31730915 DOI: 10.1016/j.hansur.2019.10.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - G Pfister
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - M Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Pietton
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - R Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
| | - F Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26, avenue du Docteur Arnold Netter, 75571 Paris cedex 12, France
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Pons C, Eddi D, Le Gal G, Garetier M, Ben Salem D, Houx L, Fitoussi F, Quintero N, Brochard S. Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol. BMJ Open 2019; 9:e032901. [PMID: 31575585 PMCID: PMC6773354 DOI: 10.1136/bmjopen-2019-032901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In children with brachial plexus birth injury (BPBI), denervation of the shoulder muscles leads to bony deformity in the first months of life, reducing active and passive range of motion (ROM) and causing activity limitation. The aim of this multicentre randomised controlled trial is to evaluate the effectiveness of botulinum toxin injections (BTI) in the shoulder internal rotator muscles of 12-month-old babies in limiting the progression of posterior subluxation of the glenohumeral joint, compared with a sham procedure mimicking BTI. The secondary aims are to evaluate the effectiveness of BTI in (1) limiting the progression of glenoid retroversion and three-dimensional (3D) deformity and (2) improving shoulder ROM and upper limb function, as well as to confirm the tolerance of BTI. METHODS AND ANALYSIS Sixty-two babies with unilateral BPBI and a risk of posterior humeral head subluxation will be included. Only those with at least 7% posterior subluxation of the humeral head compared with the contralateral shoulder on the MRI will be randomised to one of two groups: 'BTI' and 'Sham'. The BTI group will receive BOTOX injections at the age of 12 months in the internal shoulder rotator muscles (8 UI/kg). The sham group will undergo a sham BTI procedure. Both groups will undergo repeated shoulder MRI at 18 months of age to quantify changes in the percentage of posterior migration of the humeral head (primary outcome), glenoid version and 3D bone deformity. Clinical evaluations (passive shoulder ROM, active movement scale) will be carried out at baseline and 15 and 18 months of age. The mini-assisting hand assessment will be rated between 10 and 11 months and at 18 months of age. Adverse events will be recorded at least monthly for each child. ETHICS AND DISSEMINATION Full ethical approval for this study has been obtained. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER EudraCT: 2015-001402-34 in European Clinical Trial database; NCT03198702 in Clinical Trial database; Pre-results.
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Affiliation(s)
- Christelle Pons
- Pediatric rehabilitation department, Fondation ILDYS, Brest, France
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France
- Physical Medicine and Rehabilitation department, Brest CHRU, Brest, France
| | | | - Gregoire Le Gal
- Centre for Clinical Investigation INSERM CIC 1412, Brest CHRU, Brest, France
| | - Marc Garetier
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France
- Radiology department, Hopital d'Instruction des Armees Clermont-Tonnerre, Brest, France
| | - Douraied Ben Salem
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France
- Radiology department, Brest CHRU, Brest, France
- Medical School, Université de Bretagne Occidentale, Brest, France
| | - Laetitia Houx
- Pediatric rehabilitation department, Fondation ILDYS, Brest, France
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France
- Physical Medicine and Rehabilitation department, Brest CHRU, Brest, France
| | - Franck Fitoussi
- CHU Paris Est - Hôpital d'Enfants Armand-Trousseau, Paris, France
| | - Nathaly Quintero
- Physical Medicine and Rehabilitation department, Hopitaux de Saint-Maurice, Saint Maurice, France
| | - Sylvain Brochard
- Pediatric rehabilitation department, Fondation ILDYS, Brest, France
- Laboratory of Medical Information Processing (LaTIM), INSERM UMR 1101, Brest, France
- Physical Medicine and Rehabilitation department, Brest CHRU, Brest, France
- Medical School, Université de Bretagne Occidentale, Brest, France
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Martinot-Lagarde C, Quintero-Prigent N, Brennetot N, Clavier F, Peyre I, Chamberon M, Fiat M, Fahmy M, Fitoussi F, Verloes A. Use and interest of adjustable passive prosthesis (mechanical without control) in children. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE Nerve transfers to restore elbow flexion have been described for traumatic brachial plexus palsy in adults. Indications are less frequent in infants and the results are less published. METHODS Ten patients with obstetrical brachial plexus palsy were operated on for lack of flexion against gravity with ulnar or median nerve transfer to biceps motor branch. The primary endpoint was improvement in elbow flexion and supination. RESULTS Mean age at surgery was 12.5 months and mean follow-up was 2.6 years. The Active Movement Scale (AMS) was used to evaluate elbow flexion and forearm supination. At the last follow-up, the average AMS score improved from 0.3 to 5.7 for elbow flexion and from 0.6 to 5.8 for forearm supination. There was no statistical correlation between the age at surgery and the AMS score 18 months post-operatively. CONCLUSIONS Nerve transfer to the biceps motor branch can improve elbow flexion and forearm supination in selected patients with upper lesions and can be safely performed until the age of two years.
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Affiliation(s)
- J. Murison
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris 6 University, Paris, France
| | - P. Jehanno
- Department of Pediatric Orthopedic Surgery, Robert Debre Hospital, Paris, France
| | - F. Fitoussi
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris 6 University, Paris, France,Correspondence should be sent to F. Fitoussi, Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris 6 University, Paris, France. E-mail:
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Herisson O, Maurel N, Diop A, Le Chatelier M, Cambon-Binder A, Fitoussi F. Shoulder and elbow kinematics during the Mallet score in obstetrical brachial plexus palsy. Clin Biomech (Bristol, Avon) 2017; 43:1-7. [PMID: 28161491 DOI: 10.1016/j.clinbiomech.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The physical signs of obstetrical brachial plexus palsy range from temporary upper-limb dysfunction to a lifelong impairment and deformity in one arm. The aim of this study was to analyze the kinematics of the upper limb and to evaluate the contribution of glenohumeral and scapulothoracic joints of obstetrical brachial plexus palsy children. METHODS Six children participated in this study: 2 males and 4 females with a mean age of 11.7years. Three patients had a C5, C6 lesion and 3 had a C5, C6, C7 lesion. They were asked to perform five tasks based on the Mallet scale and the kinematic data were collected using the Fastrak electromagnetic tracking device. FINDINGS The scapulothoracic protraction and posterior tilt were significantly increased in the involved limb during the hand to mouth task (p=0.006 and p=0.015 respectively). The scapulothoracic Protraction/glenohumeral Elevation ratio was significantly increased in the involved limb during the hand to neck task (p=0.041) and the elevation task (p=0.015). The ratios of scapulothoracic Tilt on the three glenohumeral excursion angles were significantly increased during the hand to mouth task (p≤0.041). The scapulothoracic Mediolateral/glenohumeral Elevation ratio was significantly increased in the involved limb during the elevation task (p=0.038). The glenohumeral elevation excursion was significantly decreased in the involved limb during the hand to neck task (p<0.001) and the elevation task (p=0.0003). INTERPRETATION This study gives us information about the greater contribution of the scapulothoracic joint to shoulder motion for affected arm of obstetrical brachial plexus palsy patients compared to their unaffected arm. Kinematic analysis could be useful in shoulder motion evaluation during the Mallet score and to evaluate outcomes after surgery.
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Affiliation(s)
- Olivier Herisson
- Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - Nathalie Maurel
- Ecole Nationale Supérieure d'Arts et Métiers - Equipe Biomécanique et Remodelage Osseux, 151 boulevard de l'Hôpital, 75013 Paris, France.
| | - Amadou Diop
- Ecole Nationale Supérieure d'Arts et Métiers - Equipe Biomécanique et Remodelage Osseux, 151 boulevard de l'Hôpital, 75013 Paris, France.
| | - Morgane Le Chatelier
- Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
| | | | - Franck Fitoussi
- Hôpital Trousseau, Service de chirurgie orthopédique pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Université Pierre et Marie Curie, 91 Boulevard de l'Hôpital, 75013 Paris, France.
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Otayek S, Ramanoudjame M, Fitoussi F. Les fractures de l’extrémité distale du radius chez l’enfant. Hand Surgery and Rehabilitation 2016; 35S:S150-S155. [DOI: 10.1016/j.hansur.2016.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/14/2016] [Accepted: 02/19/2016] [Indexed: 11/25/2022]
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Abstract
UNLABELLED Twenty adolescents with severe spastic deformities of the wrist (Zancolli type 3) and poor function on the House score were operated on between 2009 and 2014, and included in this retrospective cohort study. All were treated by wrist arthrodesis combining a proximal row carpectomy, curetting of the distal radius in order to imbed the capitate and a dorsal locking plate. The primary endpoint was improvement in the House score. Secondary endpoints included pre- and postoperative wrist flexion deformity, bone union, patient satisfaction regarding appearance and complications. The mean follow-up was 22 months. The mean age at the time of surgery was 16.2 years. Additional soft-tissue release was necessary in eight wrists. The mean House score improved significantly from 0.9 to 2.7. Average flexion deformity improved significantly from 66° to 10°. Bony union was achieved in all patients within 6 months. Four of the 20 patients required hardware removal because of fixed extension of the middle metacarpal. Wrist arthrodesis combining proximal row carpectomy with the use of a dorsal locking plate is a safe and reliable technique to improve function and appearance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Donadio
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris, France
| | - P Upex
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris, France
| | - M Bachy
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedic and Reconstructive Surgery, Trousseau Hospital, Paris, France
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Pons C, Mickael D, Fitoussi F, D’Anjou MC, Porte M, Rumilly E, Quintero N, Violas P, Brochard S. Safety and effectiveness of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with obstetrical brachial plexus palsy: Presentation of a multicentre randomised double-blind placebo-controlled trial. Ann Phys Rehabil Med 2016. [DOI: 10.1016/j.rehab.2016.07.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fitoussi F, Ghorbani A, Jehanno P, Frajman JM, Penneçot GF. Thenar Flap for Severe Finger Tip Injuries in Children. ACTA ACUST UNITED AC 2016; 29:108-12. [PMID: 15010153 DOI: 10.1016/j.jhsb.2003.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Accepted: 10/17/2003] [Indexed: 10/26/2022]
Abstract
Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distal-based thenar flap. The injuries were palmar oblique amputations or avulsion injuries involving the pulp and the nail bed. The pedicles of the thenar flaps were divided after 18 to 25 days and none suffered any necrosis. At the final follow-up, no interphalangeal joint contractures were found, the average two point discrimination was 5 mm, the thenar scar was asymptomatic and the subcutaneous tissue of the thenar flap was providing sufficient bulk to produce a rounded contour, like a normal fingertip. The thenar flap is a useful technique for use with severe fingertip injuries when local flaps cannot provide enough soft tissue and replantation is not possible.
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Affiliation(s)
- F Fitoussi
- Department of Orthopaedic Surgery, Robert Debre Hospital, Paris, France.
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Gibon E, Romana C, Vialle R, Fitoussi F. Isolated C5-C6 avulsion in obstetric brachial plexus palsy treated by ipsilateral C7 neurotization to the upper trunk: outcomes at a mean follow-up of 9 years. J Hand Surg Eur Vol 2016; 41:185-90. [PMID: 26141020 DOI: 10.1177/1753193415593493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/11/2015] [Indexed: 02/03/2023]
Abstract
Cervical root avulsions are the worst pattern of injury in obstetrical brachial plexus injury (OBPI). The prognosis is poor and the treatment is mainly surgical with extraplexual neurotizations or muscle transfers. We present the outcomes of a technique performed in our institution to treat C5-C6 avulsion in obstetrical brachial plexus injury. This technique consists of a total ipsilateral C7 neurotization to the upper trunk. Ten babies with isolated C5-C6 root avulsion were operated on; we were able to review nine of them at over 12 months follow-up. The shoulder and the elbow function were assessed, as well as the Mallet Score. The mean follow-up was 9.2 years (SD 5.7). After a follow-up of 6 years, elbow flexion was restored with a range of motion ⩾130° and a motor function ⩾M3 in all patients. The average Mallet score was 18.1 (SD 1.2). This approach appears to be a viable alternative to extraplexual neurotizations for the treatment of C5-C6 nerve root avulsion.
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Affiliation(s)
- E Gibon
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Paris, France
| | - C Romana
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Paris, France
| | - R Vialle
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Paris, France
| | - F Fitoussi
- Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Paris, France
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Romana C, Ciais G, Fitoussi F. Treatment of severe radial club hand by distraction using an articulated mini-rail fixator and transfixing pins. Orthop Traumatol Surg Res 2015; 101:495-500. [PMID: 25907512 DOI: 10.1016/j.otsr.2015.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of severe radial club hand is difficult. Several authors have emphasized the importance of preliminary soft-tissue distraction before centralization. HYPOTHESIS Treatment of severe radial club hand by articulated mini-rail allowing prior soft-tissue distraction improves results. MATERIAL AND METHODS Thirteen patients were treated sequentially, with an initial step of distraction and a second step of centralization. The first step consisted in fitting 2 mini-fixators, one in the concavity and the other in the convexity of the deformity. Four transfixing wires through the ulna and metacarpal bone connected the 2 fixators. After this preliminary distraction, the fixator was removed and a centralization wire was introduced percutaneously, with ulnar osteotomy if necessary. Sagittal and coronal correction was measured on the angle between forearm and hand. RESULTS Mean age at treatment was 37.5 months (range, 9-120 months). Mean distraction time was 53.2 days (26-90 days). Ulnar osteotomy was required in 8 cases (61%). There were no major complications requiring interruption of distraction. Sagittal and coronal correction after centralization reduced mean residual forearm/hand angulation to<12°. DISCUSSION Soft-tissue distraction in the concavity ahead of centralization is essential to good correction, avoiding extensive soft-tissue release and hyperpressure on the distal ulnar growth plate. There have been several studies of distraction; the present technique, associating 2 mini-fixators connected by threaded K-wires, provided sufficient distraction in the concavity of the deformity to allow satisfactory correction in all cases. Subsequent complications (breakage or displacement of the centralization wires) testify to the complexity of long-term management. CONCLUSION The present study confirms the interest of a preliminary soft-tissue distraction step in treating severe radial club hand.
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Affiliation(s)
- C Romana
- Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France; Centre de référence des malformations des membres, hôpital national de Saint-Maurice, Saint-Maurice, France
| | - G Ciais
- Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France
| | - F Fitoussi
- Service de chirurgie orthopédique et réparatrice de l'enfant, UPMC université Paris 06, hôpital Trousseau, Paris, France; Centre de référence des malformations des membres, hôpital national de Saint-Maurice, Saint-Maurice, France.
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Abstract
Tendon lengthening and transfer are usually indicated for certain neuromuscular disorders, peripheral or central nerve injury, congenital disorder or direct traumatic or degenerative musculotendinous lesion. In musculotendinous lengthening, technique depends on muscle anatomy, degree of correction required, and the need to avoid excessive loss of force. Lengthening within the muscle or aponeurosis is stable. In the tendon, however, it may provide greater gain but is not stable and requires postoperative immobilization to avoid excessive lengthening. Tendon transfer consists in displacing a muscle's tendon insertion in order to restore function. The muscle to be transferred is chosen according to strength, architecture and course, contraction timing, intended direction, synergy and the joint moment arm to be restored. Functions to be restored have to be prioritized, and alternatives to transfer should be identified. The principles of tendon transfer require preoperative assessment of the quality of the tissue through which the transfer is to pass and of the suppleness of the joints concerned. During the procedure, transfer tension should be optimized and the neurovascular bundle should be protected. The method of fixation, whether tendon-to-bone or tendon-to-tendon suture, should be planned according to local conditions and the surgeon's experience.
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Affiliation(s)
- F Fitoussi
- Hôpital Trousseau, Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Université Pierre-et-Marie-Curie, 26, rue du Dr-Arnold-Netter, 75012 Paris, France.
| | - M Bachy
- Hôpital Trousseau, Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Université Pierre-et-Marie-Curie, 26, rue du Dr-Arnold-Netter, 75012 Paris, France
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Affiliation(s)
- F Fitoussi
- Service de chirurgie orthopédique et reconstructrice de l'enfant, université Pierre-et-Marie-Curie, hôpital Trousseau, 26, rue du Dr-Arnold-Netter, 75012, Paris, France.
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Fitoussi F, Delpont M. [Acute limping in children between 1 and 4 years old]. Arch Pediatr 2014; 21:552-5. [PMID: 24686039 DOI: 10.1016/j.arcped.2014.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 11/25/2022]
Abstract
Recent limping in children aged between 1 and 4 years old are often a diagnostic problem because the young child may not be able to show the area of pain. Dominated by the traumatic causes like hairline fracture, the physician should eliminate the most severe, including infectious etiologies that require urgent treatment. The clinical examination is fundamental and simple complementary investigations like standard X-rays and biology (blood count cell, C reactive protein) looking for increased inflammatory parameters will help to find the cause in the majority of cases. The persistence of a limp beyond a week involves the realization of bone scan or MRI imaging.
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Affiliation(s)
- F Fitoussi
- Service de chirurgie orthopédique et réparatrice de l'enfant, hôpital Trousseau, université Paris-6-Pierre-et-Marie-Curie, 26, rue du Dr Arnold-Netter, 75012 Paris, France.
| | - M Delpont
- Service de chirurgie orthopédique et réparatrice de l'enfant, hôpital Trousseau, université Paris-6-Pierre-et-Marie-Curie, 26, rue du Dr Arnold-Netter, 75012 Paris, France
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Jehanno P, Mas V, Fitoussi F, Frajman JM, Valenti P, Mazda K. [Metacarpal osteoarticular injuries in children]. Chir Main 2013; 32 Suppl 1:S29-S38. [PMID: 23796792 DOI: 10.1016/j.main.2013.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 01/05/2013] [Accepted: 02/16/2013] [Indexed: 06/02/2023]
Abstract
Metacarpal fractures and dislocations in the fingers are common injuries in children's hands. Most of these can be treated successfully non-operatively, although a subset requires more aggressive treatment. Results following appropriate care in children are generally good. Twenty percent of them need a reduction, need for surgical stabilization is rare. Each injury is presented, including diagnostic, therapeutic principles, pitfalls to prevent and potential complications.
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Affiliation(s)
- P Jehanno
- Urgences mains-enfants, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Fitoussi F. [Finger bone and joint trauma of the hand in children]. Chir Main 2013; 32 Suppl 1:S7-15. [PMID: 23642705 DOI: 10.1016/j.main.2013.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/24/2013] [Accepted: 03/13/2013] [Indexed: 12/01/2022]
Abstract
The hand is the most commonly injured location of a child. Fractures of the digits are the most frequent lesions with two specific locations: 1) in the young child, the fracture is usually a crush injury, such as occurs when a hand gets caught in a door, with lesion of the distal phalanx; soft tissue associated injuries are the main problem in this location; 2) in the older child, the fracture is usually secondary to recreational sports, with lesion on the proximal phalanx of the second and fifth digits. Dislocations or sprains are less common. Most interphalangeal joint injuries occur at the proximal interphalangeal joint and are secondary to hyperextension with as results a volar plate injury. Most fingers injuries in children are treated non operatively with a favorable outcome. The treating physician should however identify those clinical situations that require surgery, as complications are most commonly due to a failure to identify and treat an injury requiring an operation acutely. These injuries include intra-articular fractures, displaced phalangeal neck fractures, and malrotated fractures. Malrotation or intra-articular malunion have no remodeling capacity. Non-union and stiff digits are uncommon but a significant trauma or a high-energy mechanism with severe soft tissues injuries appears to be a factor of risk.
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Affiliation(s)
- F Fitoussi
- Service de chirurgie orthopédique et réparatrice de l'enfant, université Paris 6, hôpital Trousseau, 26, rue du Dr-Netter, 75012 Paris, France.
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Abstract
The hand is one of the most commonly injured locations in children. In the young child, the ignorance of dangers may explain this frequency. In the older child, hand trauma is usually secondary to recreational sports. Most hand injuries in children are treated nonoperatively because of high remodeling potential. Surgical treatments are mandatory in case of open or unstable fracture, displaced intraarticular fractures and displaced phalangeal neck fractures. In phalangeal neck fractures, percutaneous treatment should be preferred. Finger stiffness and non-union are uncommon and are usually in relation with skin or vascular involvement. In case of physis fracture, clinical and radiological follow-up should monitor any growth problems.
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Affiliation(s)
- F Fitoussi
- Service de chirurgie orthopédique et réparatrice de l'enfant, université Paris VI, hôpital Trousseau, 26, rue du Docteur-Netter, 75012 Paris, France.
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Sales de Gauzy J, Fitoussi F, Jouve JL, Karger C, Badina A, Masquelet AC. Traumatic diaphyseal bone defects in children. Orthop Traumatol Surg Res 2012; 98:220-6. [PMID: 22349205 DOI: 10.1016/j.otsr.2012.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/03/2011] [Indexed: 02/02/2023]
Abstract
UNLABELLED Traumatic bone defects (BD) are rare in children. There are no pediatric series in the literature on this topic. The aim of this first pediatric series was to determine the epidemiological characteristics and evaluate the results of different treatments in this entity. MATERIAL AND METHODS This retrospective multicenter study evaluated diaphyseal bone defects in cases in which bone reconstruction was performed. BD was either initial and associated with trauma or secondary, resulting from infected non-union. RESULTS The series included 27 patients (17 boys and 10 girls), mean age 11.4 years old (3-16) (20 traffic accidents). At the outset of all patients' history was an open fracture (one stage 1, seven stage 2, 11 stage 3A and seven stage 3B, 1 NR). BD involved 13 tibias, 9 femurs, three humerus, one radius and one ulna. Bone defects were initial in 20 cases and secondary in seven cases. They were less than 2 cm in two cases, between 2 and 5 cm in 9 cases, between 5 and 10 cm in 10 cases and more than 10 cm in six cases. Treatment of BD was immediate in one case and delayed in 26 cases. Techniques used included: induced membrane in 10 cases, bone transport in seven cases, bone autograft in eight cases, vascularized fibular transfer in one case, no bone reconstruction in one case. Union was obtained in 27 patients. Union was obtained within a mean 12.3 months BD (3-62). Fifteen patients presented with sequellae. DISCUSSION Traumatic bone defects have a better prognosis in children than in adults. The thicker, more active and richly vascularized periosteum in children is an important prognostic factor. Treatment of BD requires good initial bone stabilization. Reconstruction depends on the integrity of the periosteum. In case of an intact periosteum, bone reconstruction does not seem necessary in young children. If one part of the periosteum is intact, a simple autograft seems sufficient even with extensive bone defects. In the absence of the periosteum or especially in case of infection, the induced membrane technique seems preferable, with bone transport or a vascularized bone transfer. LEVEL OF EVIDENCE IV: retrospective study.
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Affiliation(s)
- J Sales de Gauzy
- Department of Pediatric Orthopaedic Surgery, Children Hospital, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
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Lonjon G, Barthel PY, Ilharreborde B, Journeau P, Lascombes P, Fitoussi F. Bone bridge resection for correction of distal radial deformities after partial growth plate arrest: two cases and surgical technique. J Hand Surg Eur Vol 2012; 37:170-5. [PMID: 21708842 DOI: 10.1177/1753193411413069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Partial closure of the growth plate is an uncommon complication in the distal radius even though distal radial fractures are among the most common injuries in children. We report two cases of resection of a bony bridge in the distal radial growth plate in boys aged 8 and 9 years with a description of the operative technique.
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Affiliation(s)
- G Lonjon
- Service de chirurgie orthopédique infantile, Hôpital Robert Debré APHP, Paris, France
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Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012; 98:97-102. [PMID: 22244249 DOI: 10.1016/j.otsr.2011.11.001] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 11/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Among bone reconstruction techniques, the induced membrane technique, proposed in 1986 by Masquelet, has rarely been studied or evaluated in the surgical literature until recently. The 2010 French Society of Orthopaedic Surgery and Traumatology (SoFCOT) Annual Convention symposium was the occasion to evaluate a large cases series having used this technique. PATIENTS AND METHODS This retrospective study included 84 posttraumatic diaphyseal long bone reconstructions using the induced membrane technique (1988-2009). The series included 79 men and five women (mean age 32-year-old). In 89% of cases, the initial trauma was an open fracture. The leg was involved in 70% of cases. The mean delay between the accident and treatment of bone defects (BD) was 8 months. In 50% of the cases, infection was present. Bone defects were larger than 5cm in 57% of the cases. RESULTS Union was obtained in 90% of cases, a mean 14.4 months after the first stage of the reconstruction. A mean 6.11 interventions were necessary to obtain union. Malalignment was present in 17% of cases. Delayed interventions to correct deformities mostly of the foot were necessary in 16% of the cases. Eight failures (10%) involved severe leg traumas associating extensive bone defects, soft tissue lesions and infection and required amputation in six cases. DISCUSSION This series emphasizes the severity of open fractures of the leg, especially those with primary or secondary infection. The induced membrane technique has been shown to be effective in treating bone defects, regardless of their magnitude. In a two-step procedure, this simple but demanding technique, which may be more complicated when repair of soft tissue is necessary, provides successful treatment in case of initial infection and fulfills the goal of controlling infection before bone reconstruction. Moreover, the induced membrane technique can be integrated in hybrid reconstruction procedures. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- C Karger
- Department of Pediatric Surgery, Hautepierre Teaching Hospital Center, Strasbourg, France
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Ilharreborde B, Gaumetou E, Souchet P, Fitoussi F, Presedo A, Penneçot GF, Mazda K. Efficacy and late complications of percutaneous epiphysiodesis with transphyseal screws. ACTA ACUST UNITED AC 2012; 94:270-5. [DOI: 10.1302/0301-620x.94b2.27470] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Percutaneous epiphysiodesis using transphyseal screws (PETS) has been developed for the treatment of lower limb discrepancies with the aim of replacing traditional open procedures. The goal of this study was to evaluate its efficacy and safety at skeletal maturity. A total of 45 consecutive patients with a mean skeletal age of 12.7 years (8.5 to 15) were included and followed until maturity. The mean efficacy of the femoral epiphysiodesis was 35% (14% to 87%) at six months and 66% (21% to 100%) at maturity. The mean efficacy of the tibial epiphysiodesis was 46% (18% to 73%) at six months and 66% (25% to 100%) at maturity. In both groups of patients the under-correction was significantly reduced between six months post-operatively and skeletal maturity. The overall rate of revision was 18% (eight patients), and seven of these revisions (87.5%) involved the tibia. This series showed that use of the PETS technique in the femur was safe, but that its use in the tibia was associated with a significant rate of complications, including a valgus deformity in nine patients (20%), leading us to abandon it in the tibia. The arrest of growth was delayed and the final loss of growth at maturity was only 66% of that predicted pre-operatively. This should be taken into account in the pre-operative planning.
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Affiliation(s)
- B. Ilharreborde
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - E. Gaumetou
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - P. Souchet
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - F. Fitoussi
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - A. Presedo
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - G. F. Penneçot
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
| | - K. Mazda
- Robert Debré Hospital, Paediatric
Orthopaedic Department, 48 BD Sérurier, 75019 Paris, France
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Fitoussi F, Maurel N, Diop A, Laassel EM, Ilharreborde B, Presedo A, Mazda K, Penneçot GF. Upper extremity kinematics analysis in obstetrical brachial plexus palsy. Orthop Traumatol Surg Res 2009; 95:336-42. [PMID: 19559664 DOI: 10.1016/j.otsr.2009.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 04/08/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several recent studies demonstrate that upper extremities kinematics analysis is in increasing use to assist clinical practice. We describe an upper limb kinematics analysis protocol that was first applied to a group of healthy children (to obtain normative data), and subsequently, to a child presenting with obstetrical brachial plexus palsy (OBPP) before and after surgical treatment. MATERIALS AND METHODS The protocol is based on two very simple tasks. Reflective markers are placed on the studied segments, and optoelectronic cameras three-dimensionally record the position of the markers during the course of movement. The data, collected by a Vicon system (Oxford Metrics Ltd., Oxford, UK), are analyzed by a dedicated software; this software provides coefficient of multiple correlation (CMC) for the comparison of different kinematics curves and motion amplitudes. A CMC above 0.95 was considered to be excellent, between 0.85 and 0.95 was good, and below 0.85 was poor. Twelve healthy children, average age 9.7 years (from 7 to 14 years), were analyzed. A 7-year-old patient presenting left OBPP was similarly analyzed, pre- and postoperatively, after a lateral rotation osteotomy of the humerus. RESULTS The analysis of the 12 healthy children established a kinematics corridor for each task and each angle considered. Analysis of the pathological patient revealed kinematics anomalies during movement which went undetected at simple clinical examination. CMC analysis after treatment showed improvement of all movements around the shoulder, going from "poor" preoperatively to "excellent" postoperatively. Amplitudes analysis similarly demonstrated postoperative improvement, which increased from 28 to 67% according to the rotations considered, around the shoulder and elbow. The interest in these results should be confirmed by studies in a larger number of patients. DISCUSSION Upper extremity kinematics analysis is increasingly utilized in current clinical practice. Although many problems occur because of the non-cyclical and non-automatic nature of movement, review of the literature and our preliminary results show that reproducibility is satisfactory. Interest in our work arises from helping develop a preoperative evaluation tool (providing a more global view of abnormalities) as well as a postoperative assessment one (for the quantification of movement gains obtained by surgery after humeral osteotomy). LEVEL OF EVIDENCE Level IV. Diagnostic retrospective study.
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Affiliation(s)
- F Fitoussi
- Pediatric Orthopaedics Department, Robert-Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France.
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Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Presedo A, Souchet P, Penneçot GF, Mazda K. How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop 2008; 28:733-9. [PMID: 18812899 DOI: 10.1097/bpo.0b013e318185a36b] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The selection of fusion levels continues to be controversial in adolescent idiopathic scoliosis (AIS). The classifications of King and Lenke remain the most widely used, but recent studies have demonstrated their shortcomings, including poor interobserver reproducibility. We propose a method of preoperative planning that is independent of anatomical classifications, based on the anticipated effect of curve reduction. The objectives of this preoperative strategy are (1) to achieve satisfactory T1 tilt and shoulder balance and (2) to restore balance in the coronal and sagittal planes. The purpose of the present study was to evaluate the results of our strategy of deciding the proximal level of arthrodesis in Lenke types 1 and 2 AIS. METHODS We included 132 adolescents operated on for thoracic AIS by posterior instrumentation. The choice of the proximal fusion level was based on preoperative analysis of the rigidity of the proximal curvature, T1 tilt, and shoulder balance. The preoperative, postoperative, and last follow-up radiographs were digitized then analyzed using computer software. Radiological parameters were compared using paired t tests. RESULTS Average age at the time of surgery was 15.2 years (SD, 1.7 years). Mean follow-up was 30.2 months. The clavicle angle and T1 tilt were significantly improved in both Lenke types 1 and 2 curves. No correlation was found between T1 tilt and shoulder balance. At last follow-up, 89% of the patients satisfied all criteria for balance. CONCLUSIONS The results of the present preoperative strategy, to which we adhered in 97% of cases, are encouraging and show that the systematic instrumentation of the entire proximal curvature is not justified in Lenke type 2 curves. However, long-term consequences of the residual T1 tilt need to be studied further.
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Affiliation(s)
- Brice Ilharreborde
- Department of Pediatric Orthopaedic, Robert Debré Hospital, Paris 7 University, Paris, France.
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Mazda K, Ilharreborde B, Even J, Lefevre Y, Fitoussi F, Penneçot GF. Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp. Eur Spine J 2008; 18:158-69. [PMID: 19089466 DOI: 10.1007/s00586-008-0839-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 09/16/2008] [Accepted: 11/16/2008] [Indexed: 12/01/2022]
Abstract
Correction of adolescent idiopathic scoliosis (AIS) has been reported with various systems. All-screw constructs are currently the most popular, but they have been associated with a significant decrease in thoracic kyphosis, with a potential risk of junctional kyphosis, not observed with hybrid constructs in the literature. In addition, it is important to weigh potential advantages of pedicle screw fixation against risks specific to its use. Because hybrid constructs are associated with a lower risk of complications and better sagittal correction than all-screw constructs, at present we use lumbar pedicle screws combined with a new sublaminar connection to the spine (Universal Clamps) at thoracic levels. The purpose of this study was to determine the efficacy and safety of the Universal Clamp (UC) posteromedial translation technique for correction of AIS. Seventy-five consecutive patients underwent posterior spinal fusion and hybrid instrumentation for progressive AIS. Correction was performed at the thoracic level using posteromedial translation. At the lumbar level, correction was performed using in situ contouring and compression/distractions maneuvers. A minimum 2-year follow-up was required. Medical data and radiographs were prospectively analyzed and compared using a paired t test. The average age at surgery was 15 years and 4 months (+/-19 months). The average number of levels fused was 12+/-1.6. The mean follow-up was 30+/-5 months. The average preoperative Cobb angle of the major curve was 60 degrees+/-20 degrees. The immediate postoperative major curve correction averaged 66+/-13%. The average loss of correction of the major curve between the early postoperative assessment and latest follow-up was 3.5 degrees+/-1.4 degrees . The mean Cincinnati correction index was 1.7+/-0.8 postoperatively, and 1.57+/-1 at last follow up. The mean rotation of the apical vertebra was corrected from 23.3 degrees+/-9 degrees preoperatively to 7.3 degrees+/-5 degrees at last follow up (69% improvement, P<0.0001). In the sagittal plane, the mean thoracic kyphosis improved from 23.8 degrees+/-14.2 degrees preoperatively to 32.3 degrees+/-7.3 degrees at last follow up. For the 68 patients who had a normokyphotic or a hypokyphotic sagittal modifier, thoracic kyphosis increased from 20.5 degrees+/-9.9 degrees to 31.8 degrees+/-7.4 degrees, corresponding to a mean kyphosis correction of 55% at last follow up. No intraoperative complication occurred and none of the patients developed proximal junctional kyphosis during the follow up. The principal limitation of the UC technique was the rate of proximal posterior prominence (14.6%), leading us to recommend the use of conventional claws at the upper extremity of the construct. The technique was safe, and reduced operative time, radiation exposure, and blood loss. While achieving correction of deformity in the coronal and axial planes equivalent to the best reported results of all-screw or previous hybrid constructs, the UC hybrid technique appears to provide superior correction in the sagittal plane. The excellent outcome in all three planes was maintained at 2 year follow up.
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Affiliation(s)
- Keyvan Mazda
- Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris 7 University, Paris, France
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